RETAINERS IN FIXED PARTIAL

DENTURE

INTRODUCTION

A fixed partial denture is commonly fabricated by preparing the teeth

present on either side of the missing tooth or teeth. These supporting
prepared teeth are the abutments onto which the prosthesis is cemented.
Fixed partial denture is made up of three elementary components -
retainer, pontic and connector.

Retainer:
The part of a fixed dental prosthesis that unites the abutment(s) to the
remainder1 of the restoration(GPT8).

Pontic:
An artificial tooth on a fixed dental prosthesis that replaces a missing
natural tooth, restores its function and usually fills the space previously
occupied by the clinical crown.

Connector:
The portion of affixed dental prosthesis that unites the retainer(s) and
pontic(s).
Retainer
This is used for the stabilization or retention of prosthesis. It is cemented
to the abutment.

Classification
The retainers can be classified on the following criteria:

Amount of Tooth Coverage

1. Complete coverage or full veneer retainers

 They cover all the surfaces of the abutment tooth and are
ideal retainers as they provide maximum retention.

 Most commonly used retainers for FPDs and are the

retainers of choice for extensively damaged abutment teeth.

2. Partial coverage or partial veneer retainers

 These retainers do not involve all the surfaces of the

abutment.

 Compared to full veneer retainers, they require less amount

of tooth preparation and have superior aesthetics but are
less retentive.
  Depending on the surface and area covered they are termed
as three-fourth crown, reverse three-fourth crown, four-
fifthcrown, seven-eighths, one-half crown, pinlays and
pinledges.

3. Conservative retainers

 These retainers require minimal tooth preparation and are

primarily indicated for anterior teeth.

 They cannot accept heavy occlusal load, for eg. Resin

bonded fixed partial dentures

Mechanism of Retention

1, Extracoronal retainers

Obtain retention from the external surface of the coronal part of

the abutment teeth; examples are full veneer crowns and partial
veneer crowns.

2, Intracoronal retainers

Obtain retention from within the coronal tooth structure

examples are inlays, onlays.

3.Radicular retainers

Obtain retentionfrom within the root of the abutment posts.

Materials used

1. ll metal retainers
 Can be either partial or full coverage.
 They possess good strength and are used commonly with
posterior abutments.
 They require minimal tooth preparation.

2. Metal-ceramic retainers
 Most commonly used; indicated in both anterior and
posterior teeth.
 Ceramic can be either a facing or full coverage.
 They require more tooth preparation than the all metal
type.

3. All ceramic retainers

 Most aesthetic and need maximal tooth preparation.
 Also provide the best aesthetics but strength in long-span
FPDs is still questionable.

4. Acrylic retainers
 Used for temporary fixed partial dentures.
 They are not used for definitive FPDs because of their
poor strength, colour instability, inadequate wear
resistance and poor tissue response.
Criteria for Selection of Retainers

Various factors governing the selection of retainers are as follows.

1. Abutment Angulations

 In case the abutments are parallel to each other, a full veneer

retainer can be planned and a single path of insertion can be
obtained.
 If the abutments are nonparallel owing to unfavourable tooth
positions, a partial veneer retainer along with another partial or
fullveneer retainer can be used to get a single path of prosthesis
insertion.

2. Condition of the Abutment

 If the abutment teeth are in good health, in terms of both

periodontium and caries, a partial veneer retainer can be
considered as a treatment option.
 In case the abutment is endodontically treated or extensively
damaged, a full veneer retainer is recommended
 If abutments are periodontally weak with exposure of the root
surface, conservative resin-bonded retainers are indicated.

3. Aesthetics

 Though partial veneer retainers may not involve the facial surface,
their surface, their use in aesthetic zones can be questionable when
the teeth are thin and metal may be reflected. Secondary caries is
 also a possibility because of open margins. In such circumstances,
full veneer retainers are preferred with either facing or full ceramic
coverage.
 In case of inadequate pontic space, a full veneer retainer can help
betterin managing the space to get better aesthetics.

4. Preservation of Tooth Structure

 Partial veneer preparations are more conservative than full veneer

preparations
 The buccal/facial surfaces of the teeth should be preserved for
natural aesthetics. Choice should be made depending upon all the
factors so that the longevity of the prosthesis is not compromised.
 Even etched cast retainers can be thought of a conservative
alternative.

5. Retention

 A molar exerts more force when compared to a premolar, thus it

requires more retention. Longer the span, greater is the retention
required. In both cases, full coverage retainers offer better
retention.

6. Cost

 Full veneer all ceramics retainers are recommendedin cases of

anterior tooth replacements. But they are more expensive than
metal ceramic and facing retainers.
 Hence if cost is a factor, metal-ceramic restorations can be
considered for anterior region and all metal restorations for
posteriors.

IDEAL RETAINER

 Should cause least amount of destruction to the abutment

 least destroys the outline form of the tooth.
 Marginal line should be finished with great accuracy.
 Rigidity- withstand the requisite load.
 functional adaptation and protect the tooth against its fracture.
 least destroys the cervical marginal ridge.
 Positioned margins at less susceptible to caries or recurrence of
caries
 Preparation should be made without trauma to the pulp or
surrounding tissue.
 Accurate complement to the lost tooth structure.
 Cleansable
 Aesthetic
 Retainers

Extracoronal Intracoronal Radicular

Complete Partial Inlay

Cast post
veneer Onlay
crowns
crown Prefabricated
s post
All metal 3/4th crown
All ceramic Mesial half
Metal ceramic crown
7/8th crown

Extracoronal retainers

Complete Partial
coverage crowns
COMPLETE CROWNS(FULL) VENEER CROWNS

Definition:
A restoration that covers all the coronal tooth surfaces(mesial,
distal, facial, lingual and occlusal)(GPT8).

 It is also termed as ‘full veneer crowns’ though practically only all-

metal complete crowns are ‘veneers’ or thin coverings.
 The complete crown is the restoration that replaces lost tooth
structure and imparts some measure of structural support to the
tooth.
 It covers all coronal surfaces of the tooth.
 It can be all-metal, all-ceramic or combination of metal and
ceramic.
 It can be used as a single-unit restoration or as a retainer for fixed
partial denture.
The restorative material may be :
1. All metal
2. All ceramic
3. Metal-ceramic
4. Metal with processed resin

Advantages
 Most effective retention and resistance.
 Alteration in tooth form and occlusion possible.

Disadvantages
 Extensive tooth preparation.
 Margins are close to gingivae and need meticulous maintenance.
Indications

Crown
 Presence of extensive caries.
 Large defective restorations.
 Endodontically treated teeth
 Fractured tooth.
 Need to change contour for removable partial denture retention.

Retainer for FPD

 Short abutment.
 Long-span fixed partial dentures.
 Abutment alignment needs correction.
 Greater than average occlusal forces,

Contraindications
 Poor oral hygiene.
 Young adults where pulp chambers are large.
PARTIAL VENEER CROWNS / PARTIAL COVERAGE
RESTORATIONS

Definition
A restoration that restores all but one coronal surface of a tooth or
dental implant abutment, usually not covering the facial
surface(GPT8).

 Commonly buccal/facial surface isleft intact for better aesthetics.

 It is called three-quarter crown as traditionally it was used in
anterior teeth and it involved preparing three out of four surfaces
and incisal edge was not considered. In the posterior teeth it should
be called four-fifth crown as it involves preparing a definite occlsal
surface.
 It is usually made of cast metal and gold alloys are preferred as
they can be burnished.
 It can be used as a single-unit retorationor as a retainer for fixed
partial denture.

Advantages

 Conservation of tooth structure.

 Margins are accessible by the patient to maintain and operator to
finish.
 Better periodontal response as there is limited contactbetween the
restoration and gingiva.
 Cementation is easy as there is open margin for the excess cement
to escape
 Seating of the restoration can be verified.
 Pulp testing can be performed through the unrestored portion.
Disadvantages

 Lesser retention as compared to full veneers.

 There can be some display of metal and it requires high skill to
hide the same.
 May not have adequate rigidity as retainer for a fixed prosthesis
 Tooth preparation more complicated.


Indications

Teeth with:
 Intact or minimally restored coronal tooth structure.
 Normal crown form.
 Average or greater crown length.
Teeth in aesthetic zone where conserving the
buccal/facial surface of the tooth will be aesthetically advantageous.

As a retainer for:
 Short span fixed prosthesis
 Resin-bonded fixed partial dentures.
 Average or below average occlusal forces.

Contraindications

 Short clinical crown.

 Extensively damaged tooth.
 Endodontically treated tooth.
 Retainers for long-span fixed partial dentures.
 Poorly aligned abutments.
 Dentitions with active caries or periodontal disease.
CONSERVATIVE RETAINEERS

 Require minimal tooth reduction

 Acid etching
 These dentures do not accept heavy loads
 Indicated for anterior teeth
 Have a small metallic extension which are designed to be luted
directly onto the lingual surface of the abutment tooth using resin
cement

Advantages
 non invasive to dentine
 Conservative preparation
 Reduced cost and chair slide time
 Decreased tissue irritation- supraingval margins

Disadvantages
 Plaque accumulation
 Bulky contours may be intolerable to some patients
 Not ideal for replacing more than one tooth
 RESIN BONDED FIXED PARTIAL DENTURE

Types
 Rochette bridge
 Maryland bridge
 Castmesh fixed partial denture
 Virginia bridge

ROCHETTE BRIDGE
 Wing like retainer
 Funnelshaped perforations

MARYLAND BRIDGE
 Mechanical retention
 Microporosities present on the tissue surface of the retainer created
etching.

CASTMESH FIXED PARTIAL DENTURE

 Nylon mesh is placed on the tissue surface of the retainer
wax pattern to create the microporosities
 Doesn’t require acid etching

VIRGINIA BRIDGE
 Utilizes lost salt technique to create voids in the cast metal retainer
 This provides mechanical retention
Indications
 Retainer of fixed partial denture for abutments with sufficient
enamel to etch for retention,
 Splinting of periodontally compromised teeth
 Stabilizing dentitions after orthodontic treatment.
 In young patients for replacement of anterior teeth.
 In medically compromised, indigent and adolescent patients.

Contraindications
 Patients with parafunctional habits eg Bruxisum
 Long endentulous spans, replacing multiple missing teeth
 When the facial aesthetics of abutment require improvement.
 Insufficient occlusal clearance to provide 2 to 3 mm vertical
retention eg. abraded teeth.
 Inadequate enamel surfaces to bond eg. caries, existing
restorations.
 Incisors with extremely thin faciolingual dimensions.

Advantages

 More conservation over conventional fixed prosthodontics.

 Preparation confined to tooth enamel only the potential for trauma
to pulp is minimized.
 Tissue tolerance because of supragingival margins.
 Disadvantages

 Longevity of prosthesis is questionable -

 Debonding rate increases with time.
 Higher dislodgement rate with posterior resin retained fixed partial
dentures.
 Indications for multiple retainers
 Abutment teeth with short roots.
 Lack of sufficient bone support.
 Density of alveolar bone.
 Excessive length span.
 Excessive lever arm action because of shape of anterior arch.
 Distal extension of pontic for increased function.
 Replacement of a missing cuspid.
CONCLUSION

 The objective in selection of retainer whether it involves a single

tooth, several teeth or complete restoration of masticatory
mechanism. it should restore and maintain function of dental-arch.
It should be therefore both restorative and preventive.
 To accomplish this objective preventive as well as therapeutic
measures should be utilized. The efficiency in selecting the retainer
depends on the intelligent application of mechanical,
physiological, hygenic and aesthetic principles within the limits of
the supporting tissues.
 As it is the critical component of fixed partial denture we have to
give atmost care in selection of retainer to achieve the goal in the
success of fixed partial denture.